MEDICARE: AT HOME EYECARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1115038908	UT

General Provider Information

NPI Number	:	1730311481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT HOME EYECARE INC

Provider Business Mailing Address
First Line	:	PO BOX 900606
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84090-0606
Country	:	US
Telephone Number	:	801-971-4660
Fax Number	:

Provider Business Practice Location Address
First Line	:	3761 LITTLE COTTONWOOD LN
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-6055
Country	:	US
Telephone Number	:	801-943-2333
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. ROBERT H MEEK
Credential	:	O.D.
Telephone Number	:	801-943-2333

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	09/22/2009

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